Diabetes
Take a Hike Top 5 Tips and Tricks for backpacking with diabetes
B R E AT H I N G F R E S H A I R I N T O D I A B E T E S E D U C AT I O N
Diabetes , Take a Hik e Top 5 Tips and Tricks fo r Backp ack ing with Diab etes We all know that regular exercise is one of the best tools we have for managing our diabetes. At Connected in Motion (CIM), we are big fans of physical activity, especially when it happens outside in wild places with wonderful people. Hiking is one of our favourite activities. There is something extremely satisfying and soul-nourishing about getting yourself from Point A to Point B on your own steam. But taking diabetes for a hike comes with its fair share of challenges—diabetes can be unpredictable. Balancing food, exercise, insulin adjustments, daily commitments, activities and schedules can be challenging at the best of times. Add hiking 10 to 25km a day, limited space for carrying diabetes supplies, no pharmacies, no nurse educators, inclement weather, temperature fluctuations, the potential for an animal to come along and eat your food supply at any moment and we Type 1s have got some real challenges on our hands. Hiking a mountain pass can be breathtaking, both literally and figuratively! But the thought of packing up and heading into remote wilderness areas with diabetes can be daunting—enough to make some leave their backpacks in dusty, dark corners of the closet or garage and set up shop on the couch. But not you…that’s not the Slipstreamer attitude. At CIM, our philosophy is to take on each and every challenge that diabetes throws at us, use all of our knowledge and past experiences to figure out solutions, devise plans and pack our backpacks accordingly. Every piece of knowledge you acquire about diabetes—how your body reacts to different foods, activities, stresses and situations—is a tool that you can keep with you at all times. We store every experience, situation and problem solved for future use in our ‘diabetes backpacks’. That knowledge, combined with your glucometer, test strips, insulin, syringes, pump supplies or pen, allows us the freedom to explore and to overcome any challenge we come up against—on the trail or otherwise. Though challenging, the rewards of being active and outside far outweigh the extra work we need to put in to experience wild places as adults with diabetes. In 2010, the CIM crew hiked oceanside cliffs in Nova Scotia, portage trails in Ontario, wildflower-strewn mountain passes in Alberta and alongside glacier-fed alpine lakes in British Columbia. If you have what you need in your backpack (both figuratively and literally), there ain’t no mountain high enough, ain’t no valley low enough, ain’t no river wide enough…you get the idea. At CIM, we get emails every week from Type 1s across the country asking detailed questions about getting active outside. We’ve put our heads together to compile a list of the Top 5 Tips and Tricks CIMers use when getting ready to take diabetes for a hike. Each tip originates from a CIMer’s personal experience as a Type 1 in the backcountry. Have fun and happy hiking!
The CIM Team
This Edition’s Contributors:
CHLOE STEEPE, B Ed, B Phe, BA Being diagnosed with Type 1 diabetes at age 18 pushed Chloe to pursue a degree in Physical and Health Education at Queen’s University, along with a degree in Geography. After a brief hiatus from school, she returned to complete her B.Ed with a specialization in Outdoor Experiential Education. Fully certified as an Advanced Wilderness First Responder (80 hour course), Swift Water Rescue Technician, Nahanni River Guide, Flatwater Canoe Instructor and more, Chloe has spent the past 5 years guiding extended canoe and raft trips in Ontario, Quebec, the Yukon and Northwest Territories. She has traveled extensively within Canada, as well as to Europe, South and Central America, and most recently Australia and New Zealand, where she circumnavigated the South Island of NZ by bicycle. Traveling and working for a variety of different camps, companies and organizations has allowed Chloe to see the impact that wilderness tripping and experiential education has on the average person. Inspired by the possibility of using the outdoors as a forum to engage people living with Type 1 diabetes, Chloe created Connected in Motion. In her opinion, diabetes education and support systems in Canada needed a breath of fresh air. Now was the time to do something about it.
JEN HANSON, OCT, MEd , B Ed, BKin, Jen is currently completing her Master of Education researching experiential diabetes education at Brock University. She has Bachelor of Kinesiology and Bachelor of Education degrees and has taught visual arts, physical education and special needs programming at the elementary level. Jen is certified as a Wilderness First Responder and a National Lifeguard and has additional teaching qualifications in special education, environmental education, Canadian Wildlife Federation, High Five and TRIBES programming. Jen has held Challenge Course Facilitator and Supervisor certifications with Challenges Unlimited and has 8 years of experience working with challenge courses throughout Ontario. Jen is an elementary programmer with Children with Diabetes, is a member of the Diabetes Education and Camping Association’s DLead council and will be working to facilitate the International Diabetes Federation’s Young Adult Leaders program at the 2011 World Diabetes Congress. She has also volunteered and worked with the Canadian Diabetes Association (Camp Huronda), Diabetes Hope Foundation and the JDRF. Jen grew up exposed to an abundance of sport and physical activity, but competed most passionately in rugby, hockey, ringette and wrestling. Jen attended Brock University and competed both provincially and nationally with the Varsity Wrestling team.
SAR AH KETCH ESON, B Ed, B Sc A self-proclaimed science nerd, Sarah loves being outside and watching nature happen. Sarah was diagnosed with diabetes at age 14 and after just 8 months headed off to Camp Huronda, a summer camp for children with Type 1 diabetes. That first summer led to 9 years working at camp as a counsellor, lifeguard, high ropes and climbing tower instructor and finally as coordinator for the Junior Counsellor program. Sarah graduated with a degree in Ecology and also has a Bachelor of Education. Sarah worked as an outdoor educator outside of Toronto, Ontario before moving to Calgary, Alberta where she now resides and teaches at the elementary level. Sarah has been certified as an instructor with the Canadian Wildlife Federation, a lifeguard with the Life Saving Society and a challenge course facilitator with Challenges Unlimited. She also holds certifications with High Five. Sarah has been involved with Connected in Motion since ‘the beginning’ and helped Chloe to plan the very first CIM event – Winter Slipstream 2009. Since then, Sarah has worked for Connected in Motion as a guide for hiking trips in Lake Louise, Alberta, Lake O’Hara, Yoho National Park, BC and the Juan de Fuca Trail, BC. Sarah has also volunteered with Children with Diabetes, the JDRF, the Diabetes Hope Foundation and the Canadian Diabetes Association.
Do the math: Packing your ba ckpa ck By Chlo e St eep e
Whether you are heading out for an afternoon, a weekend, a week or a month, a backpack serves multiple purposes—pantry, kitchen, bedroom, closet, entertainment center, survival hub and more. As a person with diabetes, your pack will serve another purpose—as a personal pharmacy. In addition to the usual gear, supplies, first aid and safety equipment, you have diabetes supplies to pack, and lots of them! It can be daunting when you look at the pile of gear. The 65L you bought at MEC suddenly seems like a kid’s school knapsack. Don’t distress! It’s possible! With a little planning, prioritizing and packing magic it will fit. I like to think that diabetes helps build character, therefore when it’s down to the final square inches, ditch the extra T and underwear and pack an infusion site instead! Packing is a mission-critical task. Checklists and Post-it notes are your best friends. Although the consequences of forgetting something important on an afternoon hike might be slim, forgetting (or running out of) a simple diabetes supply while on a weeklong trip in the backcountry can be a serious tripending ordeal. Nobody likes a serious-trip ending ordeal...so in the weeks leading up to your trip, have an action plan!
Trip Packing Action Plan About a 3-4 weeks before a trip: • Get out a calculator and figure out how many supplies will you need. • Make a list with your results. This will turn into your packing checklist. • Place a supply order or go to the pharmacy now (don’t leave this until the last minute!)
For a 5-day hiking trip, here’s my thought process. (Note: I’m a pumper!):
Pump Sites: One pump change every 3 days, so I should need 2 sites for 5 days. I know how sweaty hiking in the summer can be, plus factor in throwing backpacks on and off, rubbing straps and pack belts, swimming, etc so I always bring a site for every day PLUS extra!
Reservoirs: One pump change every 3 days, so I should need 2. Plus extra.
IV Prep/Alcohol Swabs/Remover Pads One pump change every 3 days, so I should need 2 or 3 each. Plus extra.
Syringes/Pen Tips For backup, I would bring enough for 2 per day, so 10. Plus extra.
Insulin Double what you should need for the trip (both short acting and long acting.) For me, I know I use about 1.3ml of fast acting insulin each pump change every 3 days (this is VERY DIFFERENT for everyone!). I know I get about 7 pump changes out of a vial. One vial for this trip will be more than enough.
Travel Loaner If you are a pumper, consider talking to your pump company about their travel loaner program. Most pump companies will ship you an extra pump in advance of a trip (some charge a fee). I bring one with me on any backcountry trip or international trip I do. I still bring a back-up plan (syringes, etc) but the extra pump gives peace of mind. I have had to use it 3 times during my travels.
Crunching Numbers Different people have different strategies for the amount of supplies they take on every trip. I normally follow the ‘double it’ rule + a few extras.
Hydration on the Trail By Chlo e St eep e Camelback, a company that makes hydration packs, says it straight up with their motto: hydrate or die. We agree; hydration is an extremely important part of staying happy and healthy on the trail. You should plan to consume at least 3L (3 Nalgene Bottles) of water per day - even more depending on the temperature and how much you are sweating. Your body loses water in many different ways, even when it’s cold out. Dehydration can be a problem for everyone. For Type 1s, it can cause your BGs to seem higher than they are. Think of a grape turning into a raisin—as it loses water and the concentration of sugar in that little fruit increases, it gets sweeter and sweeter. You want to keep all of your human body cells, plump and hydrated. Alternately, if your BGs are running high, this can result in dehydration as your body tries to flush sugar and ketones out of your system. Bottom line, test lots and drink up!
A few things to consider: •
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Pick your hydration system. Water bottle? Hydration pack? Both? Start your trip with full water bottles (but don’t plan to carry a week’s worth of water with you) Know your route and the location of potential water sources each day (streams, creeks, lakes, rivers, wells or pumps at camp sites) Have a purification plan. ‘Beaver Fever’, otherwise known as giardia, is awful. Trust us. Purify any and all water that touches your food or lips. Try a hydration pack! We find we drink A LOT more throughout the day because it’s so easy to do so—just suck on the tube. No need to stop and dig through a pack for a bottle.
Hydration and Purification Systems we like: • •
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Platypus, MSR and Camelback all make great hydration packs. Nalgene, Klean Kanteen and Sigg all make funky cool (BPAFree) bottle. Memo: Hydration is fashionable. Splash your flair. We use Katadyn and MSR filters and/or Pristine (Drops) purification systems but there are many options.
What goes in must come out If you are well hydrated, you should also be making regular bathroom breaks. Make a point within your group that this is encouraged behaviour. Take these trail breaks as opportunities to appreciate your surroundings—guaranteed you’ll find some of the best views from these loos. Be sure to follow Leave No Trace policies for stops on the trail and at camp. I often find myself trying to make up for missed drinking time during the day when I arrive at my campsite in the afternoon. Chugging back multiple Nalgenes after 5pm inevitably leads to having to pee at least once during the night (okay, more like 3 times).
Helpful tips • Sleep on the side of the tent with the door. The more Type 1s in the tent, the more doors needed! • Keep your headlight handy. I have a hanging net/attic in my tent where I keep my headlamp, meter and strips. • Consider the angle of slope and placement of your tent when you pick your spot to go. Think about it.
Fuel Your Engine By Chlo e St eep e Type 1 or not, food is one of the most important parts of a hiking trip! Food on the trail is not only nutrition and fuel, but fodder for daydreams, rewards, entertainment, and an act of teamwork as well. We love waking up to the smell of coffee brewing and a big pot of bubbling oatmeal on the camp stove. There is no better way to round out your day than sitting around the fire at night, reliving the day’s events over a big steaming plate of whole-wheat pasta and a hot mug of tea. Food is a big part of the camp experience. For hiking trips, LIGHT is the word. The trick is to pack foods that are light in weight but heavy in nutrition. Think about combining carbohydrates with proteins to give your meals and snacks serious staying power. Some of our favourite backcountry recipes come from:
CAMP COOKING: THE BLACK FEATHER GUIDE By Mark Scriver, Wendy Grater and Joanna Baker
THE TRAILSIDE COOKBOOK: A HANDBOOK FOR HUNGRY CAMPERS AND HIKERS By Pam and Don Philpott
Where the heck is my... Accessibility and Space Issues By Sarah K etcheson The fanny-pack is back. Although the modern fashionista may shun this idea, from a diabetes and hiking perspective, having a go-to, easy-toaccess place for emergency site change/test strips/ low-stuff is a must. If you can’t wrap your head around bringing back the fanny, try a SPIbelt. These were THE must-have item of the summer. They are small, light, stylish and able to hold everything you need for a day outing, SPIbelt is also a big supporter of what CIM is doing! But enough about fashion—here are the practicalities. When you are out on an extended trip, having your diabetes supplies in an accessible spot is crucial to having a good day.
A Few Tips: Pack your diabetes supplies in a few different spots; keep most of them in the main part of your pack, a few key items in an accessible pocket, a few frequently used pieces in your SPIbelt. • Pack extra pump supplies in Tupperware containers to avoid them getting crunched. Use Ziplocs, dry sacks or small toiletries bags for other items. • Double up your test strips in one container. There is room for over 100 strips in every bottle that normally has 50. Pour them together before you leave to reduce space. • Pack double and share with friends. Create two packs of supplies and keep them in two separate places—ideally one in a friend’s pack. I will always remember the hike where I had to stop on the side of
the trail and unpack every single item in my pack to find a new pump site. Not a pretty site in a rainstorm, that’s for sure! Here is what I keep in my fannypack/SPIbelt: • 1 vial of insulin • 1 glucometer and a container of test strips, doubled-up • An extra pump infusion site • A few syringes in a plastic baggie (which is another MUST have item!) • Pack of Dex4 Glucose tabs/Power Gel • Extra battery
Pump Site Woes: Finding the Perfect Placement For pumpers on the trail, where you are putting your site should also be a consideration. Think about where your pack will sit on your body and DON’T put your site there! Our findings from the summer were to put sites really high on the ribs, below and above where the pack belt rests. Also remember that you will be sweating...a lot. We are talking major drippage here. Consider extra IV prep wipes and 3M Micropore tape to prevent sweat pools. Duct tape also works in a jiff.
Who needs bear bells when you have test strips? Finally, an appeal from the mountains: hiking should be about enjoying the solitude of nature, hearing bird songs in the trees, the crunching of terrain underfoot. It should not be about hearing that annoying click-click-click of test strips bouncing up and down in your pack. So please: Consider popping a cotton ball into your container. The birds, bears, bees and heck, even the hoary marmots will thank you!
Backcountry Lows 101: The Tent Dilemma By Jen H anson smell-emitting items are stored in bear lockers/bins or sealed and hung out of reach of wildlife. But this practice presents a challenge when it comes to treating nighttime lows.
During the first few days of any backpacking trip, when I’m working to get my insulin regime ironed out, I will inevitably experience a mid-night low. But being prepared to treat a low, whilst huddled in a sleeping bag, in a tent, in the backcountry certainly presents its fair share of challenges. Among the outdoor community, it is a well-known fact that odors— be those from sunscreen, toothpaste, garbage or food— attract wildlife. At CIM we’ve heard stories, and even seen first hand, the damage that can be caused by the animals we share the backcountry with when their noses lead them to the campsite of a forgetful (or ignorant) backpacker. A prepared backpacker, however, can significantly reduce the risk of an ‘uninvited guest’ dropping in for a visit. Typically, all food, cosmetics, garbage and any other
The question arises: Where do we keep supplies to treat nighttime lows? To answer this question, we called on our Type 1 friend and resident backcountry expert. Geoff Thornton-Trump lives and works in Canmore Alberta. He is an ACMG Climbing Guide and has worked with Parks Canada. As an adventure enthusiast, Geoff has a resume of outdoor experiences as a Type 1 that we yearned to learn from, and that he so graciously offered to us. He told it to us straight and simply. “Keeping something such as a sealed granola bar on your person— inside your sleeping bag—to guard from lows is essential. There will be 50 other things that will be curious to a bear’s nose before a sealed granola bar. Shoes, for example.” Thanks Geoff!
Here are some tips and tricks that we used this summer in being low-prepared and wildlife-free: • Whatever you are keeping in your tent as your low treatment,
be sure it is fully packaged and unopened • The food you chose should be as fragrant-free as possible—even when opened • Consider packing your low treatment in an additional (clean) baggie or small Tupperware • Always take your low supplies back to the main food storage area in the morning. No food or garbage should be left alone in your tent while no one is in camp
Some of our favourite backpacking nighttime low treatments are:
• Jen – Dex4 Tabs in a tube stored inside a sealed baggie • Sarah - Unopened PowerGels stored inside a sealed baggie • Chloe - Dex4 Tabs and Fruit Source Bars in a Pelican Case • Geoff – Granola bars or PowerGels